Provider Demographics
NPI:1275870420
Name:RADADVANTAGE ILLINOIS, P.C.
Entity Type:Organization
Organization Name:RADADVANTAGE ILLINOIS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-910-6887
Mailing Address - Street 1:1351 4TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1337
Mailing Address - Country:US
Mailing Address - Phone:310-869-4148
Mailing Address - Fax:847-854-6725
Practice Address - Street 1:3805 E BELL RD
Practice Address - Street 2:SUITE 5500
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2105
Practice Address - Country:US
Practice Address - Phone:602-910-6887
Practice Address - Fax:602-635-1262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty